Federal Regulations for Assisted Living Facilities
According to the Consumer Consortium on Assisted Living, a million older Americans live in assisted living facilities nationwide--nearly half of them suffering from some form of memory impairment. The average age of assisted living residents is 83 and, by the definition of "assisted living," requires help in at least one area of skills considered necessary for living and caring for oneself. As the Baby Boom ages, these numbers are expected to rise. States are the primary regulators of these health care facilities, but the federal government does have some influence in standards and financing.
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Identification
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Assisted living facilities are long-term care facilities for individuals unable to complete essential daily living tasks. The Assisted Living Federation of America defines assisted living as a "combination of housing, personalized supportive services and health care designed to meet the individual needs" of people who need help with eating, bathing, dressing, toileting, mobility or other daily tasks. The U.S. Department of Health and Human Services (HHS) identifies assistive living as a residential setting that provides life skills assistance or a protective environment for mentally or physically limited persons.
History
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ALFs were introduced in the 1980s as a step between independent living and nursing homes that provide round-the-clock supervision and medical care. ALFs are licensed and inspected by states, not the federal government; many states have begun to regulate all long-term care facilities, including ALFs, more carefully in order to maintain their Medicaid funding.
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HHS
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HHS makes regulations concerning health care facilities that participate in Medicare. Regulations are found in 42 CFR 483 under Conditions of Participation for States and Long Term Care Facilities. Regulations include admission practices, patient assessment and medical services as well as administration, facility standards and patient's rights sections. Although the latter part of the chapter contains considerable language about nursing homes, most of it applies to all long-term care facilities.
HIPAA
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The Health Information Portability and Accountability Act of 1990 affects ALFs that provide medical billing services for their Medicare or Medicaid patients using electronic transmission (telephone, fax, email). HHS administers HIPAA regulations. HIPAA establishes billing procedures and security standards for patient records.
HUD
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HUD operates an Assisted Living Conversion Program that provides grants to owners of multi-family housing in order to facilitate conversion of existing housing to ALFs. The grant program is authorized under Section 202b of the Housing Act of 1959 and is available only to non-profit developers meeting specific requirements. Facilities must conform to all state regulations and licensing requirements and residents must meet HUD "frailty" standards in 24 CFR 891.205.
Congress
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Representatives Frank Pallone (D-NJ), John Dingell (D-Mich.) and Senator Edward Kennedy (D-Mass.) reintroduced legislation in May of 2009 similar to legislation introduced in 2007 called the Community Living Assistance Services and Supports (CLASS) Act of 2009 to create an insurance program for older Americans in need of assisted living services.
Insight
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The Assisted Living Federation of America estimates there are currently 10 million people in the United States in need of assisted living services, but, by 2020, that number will rise to 15 million. Unless a cure for Alzheimer's disease or a way to stop the aging process is found, the proliferation of AFLs will require more regulation, not less, to manage care for those who need it.
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Resources
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